Endovascular Aortic Arch Reconstruction with Parallel Grafts: A Dilemma of Excessive Endograft Oversizing

Huey-Shiuan Kuo ； Kun-Cheng Tsai ； Jer-Shen Chen

《Acta Cardiologica Sinica》 36卷4期 (2020/07) Pp. 351-359

https://doi.org/10.6515/ACS.202007_36(4).20200109A

摘要

Background: Preservation of supra-aortic branches in thoracic endovascular aortic repair plays a role in associated neurological outcomes, and the strategy varies. Objectives: This study aimed to evaluate the safety and efficacy of a parallel graft technique to reconstruct the aortic arch. Methods: From August 2014 to July 2018, a total of 25 patients with thoracic aortic pathologies requiring arch reconstruction were included. All patients underwent thoracic aortic endovascular repair (TEVAR) with a zone 1 landing aortic stent graft, a chimney graft to preserve the left common carotid artery, and a periscope graft to preserve the left subclavian artery. The associated outcomes and complications were reported. Results: Eighteen patients presented with aortic dissection, 4 with a thoracic aortic aneurysm, 1 with a penetrating aortic ulcer, 1 with a traumatic aortic injury, and 1 case of re-TEVAR. The technical success rate was 96% (24/25), but the case of immediate failure died of retrograde type A dissection. Over a mean follow-up of 32.33 months, another retrograde type A aortic dissection was detected in 1 month, and a case of early failure (＜ 1 year) and 3 cases of late failure (＞ 1 year) whose primary aortic problems recurred were detected. Conclusions: This study demonstrates a total endovascular approach to preserve supra-aortic branches with a parallel graft technique. However, the dilemma of excessive graft oversizing was disclosed due to the risk of retrograde type A dissections and an unsatisfactory durability in this small series.

關鍵字

Aortic aneurysm ； Aortic dissection ； Chimney ； Periscope ； Thoracic endovascular aortic repair